剪切波弹性成像观察糖尿病周围神经病变患者胫神经  

Shear wave elastography in observation on tibial nerve changes in patients with diabetic peripheral neuropathy

作　　者：赵威[1] 郭瑞君[1] 吴玥[2] 曹文[1] 卢瑞刚[1] 吕朝阳 尹莉[1] 吕秀章[3] ZHAO Wei;GUO Ruijun;WU Yue;CAO Wen;LU Ruigang;LYU Chaoyang;YIN Li;LYU Xiuzhang(Department of Ultrasound,Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China;Department of Neurology,Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China;Department of Echocardiography,Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China)

机构地区：[1]首都医科大学附属北京朝阳医院超声医学科,北京100020 [2]首都医科大学附属北京朝阳医院神经内科,北京100020 [3]首都医科大学附属北京朝阳医院心脏超声科,北京100020

出　　处：《中国医学影像技术》2019年第8期1142-1146,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨剪切波弹性成像(SWE)技术评价糖尿病周围神经病变(DPN)患者胫神经改变的价值。方法选取30例临床诊断为2型糖尿病伴周围神经病变患者[DPN(+)组]、30例2型糖尿病不伴周围神经病变患者[DPN(-)组]及30名健康志愿者(对照组),应用二维超声及SWE测量并比较3组双下肢远端胫神经横截面积(CSA)及弹性模量均值(Emean)。分析2型糖尿病患者胫神经CSA、运动神经传导速度(MCV)及DPN(+)组患者疼痛视觉模拟量表(VAS)评分与Emean的相关性。绘制Emean诊断DPN的ROC曲线。结果3组间胫神经CSA、Emean总体差异有统计学意义(P均<0.01),两两比较差异均有统计学意义(P均<0.01)。2型糖尿病患者胫神经CSA与Emean呈正相关(r=0.64,P<0.05),胫神经MCV与Emean呈负相关(r=-0.70,P<0.05);DPN(+)组患者VAS与Emean呈正相关(r=0.82,P<0.05)。胫神经Emean诊断2型糖尿病患者DPN最佳截断值为47.4kPa,敏感度为94.2%,特异度为80.0%。结论2型糖尿病患者胫神经硬度增加;弹性模量值可作为诊断DPN的参考指标。Objective To observe the value of shear wave elastography (SWE) in evaluating changes of tibial nerve in patients with diabetic peripheral neuropathy (DPN). Methods Thirty patients of tpye 2 diabetes mellitus with DPN (DPN [+] group), 30 patients of type 2 diabetes mellitus without DPN (DPN [-] group) and 30 healthy control subjects (control group) were selected. The cross-sectional area (CSA) and mean nerve stiffness (E mean ) of the tibial nerve in 3 groups were measured and compared with two- dimensional ultrasound and SWE. The correlation of pain visual analogue scale (VAS) with E mean in DPN (+) group as well as with tibial nerve CSA and motor nerve conduction velocity (MCV) in patients with type 2 diabetes mellitus were analyzed. ROC curve for E mean in diagnosis of DPN was drawn. Results The overall differences of tibial nerve CSA and E mean among the 3 groups were statistically significant, and the pair-wise differences were also statistically significant (all P <0.01). There was positive correlation between CSA and E mean ( r =0.64, P <0.05) and negative correlation between MCV and E mean ( r =-0.70, P <0.05) in patients with type 2 diabetes mellitus. There was also positive correlation between VAS and E mean ( r =0.82, P <0.05) in DPN (+) group. The cutoff value of the tibial nerve E mean for diagnosis of DPN was 47.4 kPa, with sensitivity of 94.2% and specificity of 80.0%. Conclusion The tibial nerve stiffness increases in patients with type 2 diabetes. Elastic modulus can be used as a reference index for diagnosis of DPN.

关 键 词：糖尿病 2型 糖尿病神经病变 超声检查 

分 类 号：R587.2[医药卫生—内分泌] R445.1[医药卫生—内科学]